A client has been taking tricyclic antidepressants for many years for the treatment of depression. The client has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this client? (Select all that apply)

Neurologic function

Strict intake and output

Liver function tests

Signs of dehydration

Urine and blood chemistry

Answer and Explanation

Correct Answer : A,B,E

Reasoning:

Choice A reason: Neurologic function must be monitored in SIADH, as excessive water retention causes hyponatremia, which can lead to cerebral edema, seizures, or altered mental status. Tricyclic antidepressants may exacerbate SIADH by stimulating ADH release, making neurologic assessment critical to detect complications like confusion or seizures early.

Choice B reason: Strict intake and output monitoring is essential in SIADH to manage fluid overload. Excessive ADH causes water retention, and tracking fluid balance helps guide fluid restriction therapy to correct hyponatremia. This ensures the nurse can assess the effectiveness of interventions and prevent worsening fluid accumulation.

Choice C reason: Liver function tests are not directly relevant to SIADH management. While tricyclic antidepressants can affect liver function, SIADH primarily involves water retention and hyponatremia, not hepatic issues. Monitoring liver function is more relevant for drug toxicity, not the fluid and electrolyte imbalances of SIADH.

Choice D reason: Signs of dehydration are not a concern in SIADH, which causes water retention and fluid overload. Dehydration is more typical of diabetes insipidus, where water loss occurs. In SIADH, the focus is on preventing excessive fluid accumulation, making dehydration monitoring unnecessary in this context.

Choice E reason: Urine and blood chemistry, including sodium and osmolality, are critical in SIADH to monitor hyponatremia and fluid status. Elevated urine osmolality and low serum sodium indicate ongoing ADH excess. Regular monitoring guides fluid restriction and therapy to correct electrolyte imbalances and prevent complications like cerebral edema.

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Correct Answer is A

Explanation

Reasoning:

Choice A reason: Megaloblastic anemia, caused by vitamin B12 or folate deficiency, impairs DNA synthesis, leading to macrocytic red blood cells. Fatigue results from reduced oxygen-carrying capacity, and a smooth, beefy red tongue (glossitis) is a classic sign due to mucosal cell turnover disruption, matching the client’s symptoms.

Choice B reason: Hemophilia, a bleeding disorder due to clotting factor deficiencies, causes bleeding tendencies like hemarthrosis, not fatigue or glossitis. It does not affect red blood cell production or mucosal tissues, making it inconsistent with the client’s symptoms of anemia and tongue changes.

Choice C reason: Thrombocytopenia, or low platelet count, causes bleeding and bruising, not fatigue or a beefy red tongue. It affects hemostasis, not red blood cell production or mucosal integrity, making it an unlikely cause of the client’s hematologic symptoms described in the scenario.

Choice D reason: Sickle cell disease causes hemolytic anemia and vaso-occlusive pain, not a smooth, beefy red tongue. Fatigue occurs from anemia, but glossitis is specific to megaloblastic anemia due to B12 or folate deficiency, not the hemoglobinopathy of sickle cell disease.

A. Sodium and potassium abnormalities B. Calcium and phosphorus abnormalities C. Sodium and chloride abnormalities D. Chloride and magnesium abnormalities

Correct Answer is A

Explanation

Reasoning:

Choice A reason: Addison’s disease, due to adrenal insufficiency, reduces aldosterone and cortisol production, leading to sodium loss (hyponatremia) and potassium retention (hyperkalemia). These electrolyte abnormalities result from impaired renal sodium reabsorption and potassium excretion, making sodium and potassium monitoring critical for managing complications like hypotension and arrhythmias.

Choice B reason: Calcium and phosphorus abnormalities are not primary concerns in Addison’s disease. These electrolytes are more affected by parathyroid or renal disorders. Addison’s disease primarily disrupts sodium and potassium balance due to aldosterone deficiency, with calcium and phosphorus typically remaining within normal ranges unless other conditions coexist.

Choice C reason: Sodium abnormalities occur in Addison’s disease due to aldosterone deficiency, causing hyponatremia. However, chloride levels are not significantly altered, as chloride follows sodium passively. Potassium imbalances (hyperkalemia) are more critical alongside sodium, making this combination less comprehensive than sodium and potassium monitoring.

Choice D reason: Chloride and magnesium abnormalities are not hallmark features of Addison’s disease. While mild chloride changes may occur with sodium loss, magnesium is typically unaffected. The primary electrolyte disturbances involve sodium (hyponatremia) and potassium (hyperkalemia), making these the focus of monitoring in adrenal insufficiency.

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A client has been taking tricyclic antidepressants for many years for the treatment of depression. The client has developed SIADH and has been admitted to the acute care facility. What should the nurse carefully monitor when caring for this client? (Select all that apply)

Nursing Test Bank

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